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HomeMy WebLinkAboutBuilding Permit #553-15 - 336 OSGOOD STREET 12/16/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: r Date Received Date Issued: r IM ORTANT:Applicant must complete all items on this page LOCATION- .136. GS cvzo�.� S7�•__._ Print PROPERTY OWNER Print 106Year Old Structure yes. no MAP NO: 0K­PARCEL:61k ZONING DISTRICT: Historic District yes no _ Machine Shop Village yes: no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building a family ❑Ad ition ❑Two or more family ❑ Industrial 1�4teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well 0 Floodplain D Wetlands 0 Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: dentification Please Type or Print Clearly) OWNER: Name: � C 1' ori Phone:M-4SCP -agSC) Address: CONTRACTOR Name: r�.C Phone: ?qtl- Add ress: Supervisor's Construction License: -7 F7 7_ Exp. Date: cflz 5 Horne Improvement Licenser _ 1- Z O -� _ Exp. Date: 312 �l<v ARCHITECT/ENGINEER Phone: ; Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1500- FEE: $ 77-2 Check No.: Receipt No.: �Zs NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund •� g, Signa ut resof Agent/Owner- Q,f16 Sigafure.of contractor { Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Building Department The fol;owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofhi,g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apn•,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?,ding permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE:OF.SEWERAGE DiSP.OSAL I Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ f well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ � Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY r INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS -CONSERVATION Reviewed on Siqnature COMMENTS HEALTH Reviewed on Signature 'COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Comments Conservation Decision: Comments I ' Water & Sewer Connection/Signature& Date Driveway Permit DPW Towo Engineer: Signature: Located 384 Osgood Street FIRE DEPARtME'SIT =Te'm' p Dumpster on site yes_. no Located at 124 Main Street Fire Depar'tmerit signature/date CO MIVI E NTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A-F and G min.$100-$1000 fine NOTES and DATA— (For department use t I i D Notified foricku - Date P p i 1 Doc.Building Permit Revised 2010 Location C v No. / '� Date e • TOWN OF NORTH ANDOVER;.--- r e 'T MDT e Certificate of Occupancy j Building/Frame Permit Fee $ •' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Q � 7 Check#� 28359 Building Inspector NORTk own o _ : .tAndover . No. +� zr, Mass oLK. C 1. COC NIC Mt WICK V p04ATED `S U BOARD OF HEALTH Food/Kitchen PER Septic SystT Dem h� �t� •••.' BUILDING INSPECTOR THIS CERTIFIES THAT .............. .. ........... .....tv Foundation has permission to erect ..... ul Ings on .......B.. .• ••• •••+• •••••••••�•••• Rough ............ O be occupied as ........... ... .w ...... ... ... .. � ��.. ............ Chimney t p provided that the person accepting this permit shall in every respect conform to the terms of the app (cation Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MON S ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TA Rough Service ........ ....... ..... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect bomeownem Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotlino at 617-973-8787 or 1-888-283-3757 or on our websitc. Homeowner Information Contractor Information Name Company dame ,11,1! /e, StreAdJess{don t is—ea Ptst Office Bos address]^, Atin Contractor/SalespeNMONPN*WIM 1 Ci !Town S all S 61 R Je60 Avenue ty State Zip Code i Business Address(must inci4tli;l�y t�)O 470 �7[U�+Ill Daytime Phone Evening Phone City/Town State Zip Code O Mailing Address(It different above) Business Phone Federal Employer ID or S.S.Number - Homeir�ros..=ComWorng.rtmnhe L•1pimtion e Ian rtgairo Wai most home ratld aandreb mmntmrslure (/i//t iw // / a ghtratioo avmher The Contractor agrees to do the following work for the Homeowner. (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets ifnecetsarv.) '41-5 Required Permits-The following building permits are required Proposed Start and Completion Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractors control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of Z Date when contractor will begin contracted work. MGL chapter 142A.) / Z/ Date when contracted work xvill be substantially completed. Total Contract Price and Payment Schedule {� The Contractor agrees to perform the work-,furnish the material and labor specified above for the total sum of. �/ (a) Pay.meennt�s�will be made according to the following schedule: S upon signing contract(not to exceed 113 of the total contract price or the cost of special order items,whichever is greater) S by / or upon completion of a, o Cv S v`v/v��, by s�� ' or upon completion of S 1✓W. upon completion of the contract- (Late forbids demon 'ng full paym t until contract is comp) ed to both party's satisfaction) The following material/equipment must be special S /be paid r ordered before the contracted work begins in order to meet the completion schedule.(**) S pal or NOTES:(•)Including all finance charges(•')Lawrequires that any deposit or dorm-payment rey the contractor before work begins may required b not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express warrant•-Is an express warranty bein¢provided b,the contractor° ❑No❑Yes(all te.ms of the warranty must be attached to the contract) Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for Materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence.Review the following cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • _ Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance'document. e Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight ofthe third business day following the signing of flus agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical copies of the contract most be completed and signed thin copy should go to the homcowmrs.The other copy should be kept by the contractor. Homeowaer's Signator Contrac�igt—ure Date Date i Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractgrInay it.he dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration-as prbitider i71n Massachusetts General Laws,ch ter 142A. Homeowner's Signa o Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate altemative dispute resolution even when this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in anyway,even by agreement. However.homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts cavy an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumerlhomeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of"A Massachusetts Consumer Guide to Home Improvement" contact Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-8787,888-283-3757 or visit the OCABR website at httnahl���c.nrass.eo�fncal)r If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-87872 888-283-3757 or visit the HIC website at httn:/!tti;-x\-.nlass.2ovlocabr/ Go online to view the status of a Home Improvement Contractor's Registration: htin:l/db.state.nla.tLsillomeiiilProyenle➢lt/llcenseelist Lisp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Corisarner Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-31 14 Version 2.1-11/22/2010 '' Prir►f Form. : The Commonwealth ofMassachussvtts U11Department of Industrial Accidentsrag - Offlce of Investdgations I Congress S'tree4 Suite 100 Boston,MA 02114-2017 wwwvmass,gov/dia Workers' Compensation Insurance Affidavit: eiders/Contractors/Electricians/Plumbers i A�u �fa�atio�l Please Paint Leftly . Name(Business/Organization/ittdividual): Atlantic Weatherization,LLC 61 R Jefferson Nvenwe Address: Catem a� 01470 City/Statel ip: Ph©ne#: 7 -71 Are You em to er?Check P Y the�propriate box: Type of project(required): 1. am a employer with 4. ® I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for ane in any capacity, employees and have workers' [No workers'comp.insurance comp.insurance.t 9• ®Building addition required.] 5. rl We are a corporation and its '10.0 Electrical repairs or additions 3.(l I am a homeowner doing all work officers have exercised their I LCI Plumbing repairs or additions Myself[No workers'comp. right of exemption per MGL 12❑Roo airs insurance required.] c. 152,§1(4),and we have no employees.[No workers' 13• ther ZN� i�L comp.insurance required.] Any applicant that checks box#(must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: tit r t Policy#or Self-ins.Lia#: 7 C7 f — I� Expiration Date: Job Site Address:._ 33 G 05G1dU City/State/Zip: AIAII-dap^ Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of critrunaI penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby cern undwthepain, and panaldes o er u that the in ormation pr®sided above is end correct e i ature: Date 2 / Phone 7qq - 3 Ficial use only. Do not write in this area,to be completed by city or town official( City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Rightfax N3-2 4/18/2014 7 :54 :21 AM PAGE 2/002 Fax Server DATE(MM1DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE TRITTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATEHO IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: EASTERN INS GROUP LLC PHONE FAX 233 WEST CENTRAL STREET (A/C,No,Ext): (A1C,No): E-MAIL NATICK,MA 01760 ADDRESS: 22MLW INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: AMERICAN ZURICH INSURANCE COMPANY ATLANTIC WEATHERIZATION LLC INSURER B: INSURER C: INSURER D: 61 REAR JEFFERSON AVE INSURER E.- SALEM, :SALEM,MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE U57ED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN LS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAD CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MM DD\YYYY) LIMITS GENERAL LIABILITY :ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR. AMAGE TO RENTED $ REMISES(Ea occurrence) ED EXP(Any one person) $ ERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY 1:1PROJECT LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION ANDX I VC STATUTORY I OTHER EMPLOYER'S LIABILITY Y/N UB-58270121-14 03/20/2014 03M2012015 LIMBS ANY PROPERITOR/PARTNER/EXECUTIVENIA E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? MN (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CER'IMCATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 1600 OSGOOD ST BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. A. VE ---�`_ N ANDOVER,MA 01845 AUTHORIZED REPR ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 19811.2010 ACORD CORPORATION. All rights reserved. A�® CERTIFICATE OF LIABILITY INSURANCE si�oi of THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CNAMONTAE:CT Construction Eastern Insurance Group LLC PHONE Exti. (508)651-7700 FAX o. 233 West Central Street E-MAIL ADDRESS* INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER AArbella Protection Ins. Co. 41360 INSURED INSURER B Arbella Indemnity Ins Co. 10017 Atlantic Weatherization INSURER C Nautilus Insurance Co 61 Rear Jefferson Avenue INSURER D: INSURER E: Salem MA 01970 INSURER F: COVERAGES CERTIFICATE NUMBERttaster 2014 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY) fMMIDDfYYM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES a occurrence) S 50,000 A CLAIMS-MADE ❑X OCCUR 8500042816 /20/2014 /20/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY FxSpAc0i LOC $ AUTOMOBILE LIABILITY Ea COMBIDD SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALLOWNEOSCHEDULED 020015871 /20/2014 /20/2015 AUTOS X AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident PIP-Basic $ 8,000 X UMBRELLA UAB [I OCCUR EACH OCCURRENCE $ 1,000,000 AEXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I I RETENTION$ 4600058654 /20/2014 /20/2015 $ WORKERS COMPENSATIONWC STATU- OTH- AND.EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/E)CECl1TIVE E.L.EACH ACCIDENT $ Of FICER/MEMBER FECCLUDED? ❑ NIA -- (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C POLLUTION LIABILITY PL200378602^ 0/1/2019 0/1/2014 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. 1.600 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER, MA 01845 Ronald Cleaves/SME ACORD 25(201 575s) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninmm ni Tha ArnRt1 name and Innn era raniatararr marine of Ar:nRn a.1 9 Massachusetts-Departmentzef Pubilc Safety Board of Bui€ding Regulations and Standards construction Stapesi-isor License: CS-087977 ; ERIC W 3HII,SNS� _ `��'�• ,n`•�'� II Salem MA 01970- F 'Expirat'ion C4 r issioc:er 04/23/2016 Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR. gisiration: 142089 Type: _ - piration: '3/12/2016 Ltd Liability Corpo- till ATLANTIC WEATHERI7ATION L.L.C. ERIC PALM 61 R JEFFERSON AVE SALEM,MA 01970. Undersecretary